Provider Demographics
NPI:1619393212
Name:KING, LAVINIA MICHELE (RN)
Entity Type:Individual
Prefix:MS
First Name:LAVINIA
Middle Name:MICHELE
Last Name:KING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 WOODSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-2963
Mailing Address - Country:US
Mailing Address - Phone:419-671-2550
Mailing Address - Fax:419-671-2595
Practice Address - Street 1:707 WOODSDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-2963
Practice Address - Country:US
Practice Address - Phone:419-671-2550
Practice Address - Fax:419-671-2595
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN156976163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse